scholarly journals Interventional Treatments for Acute and Chronic Pain: Systematic Review

2021 ◽  
Author(s):  
Roger Chou ◽  
Rongwei Fu ◽  
Tracy Dana ◽  
Miranda Pappas ◽  
Erica Hart ◽  
...  
Keyword(s):  
Usual Care ◽  
Older Patients ◽  
Interventional Procedures ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Controlled Trials ◽  
Compression Fractures ◽  
Radiofrequency Denervation ◽  
And Function

Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria. Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms. Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

scholarly journals Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 426 ◽  
Author(s):  
Cornelis ◽  
Joly ◽  
Nouri-Neuville ◽  
Ben-Ammar ◽  
Kastler ◽  
...  
Keyword(s):  
Vertebral Compression Fracture ◽  
Clinical Performance ◽  
Compression Fracture ◽  
Treatment Decision ◽  
Definitive Treatment ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Good Pain Relief ◽  
Severe Back Pain ◽  
And Function

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

scholarly journals Kyphoplasty for the treatment of an atypical osteoporotic vertebral compression fracture of the lumbar spine: A case report

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774498
Author(s):  
Sanjeev Kumar ◽  
Leon Anijar ◽  
Rishi Agarwal
Keyword(s):  
Older Patients ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Clinical Scenario ◽  
Vertebral Augmentation ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Lumbar Vertebral Body

Vertebral augmentation is a minimally invasive but sometimes technically challenging intervention typically reserved for the treatment of older patients with painful vertebral compression fractures due to osteoporosis or neoplasms. We report the successful treatment of osteoporotic vertebral compression fractures of the first lumbar vertebral body (L1) using kyphoplasty in a paraplegic young patient with multiple comorbidities. Despite the unusual and complicated clinical scenario, kyphoplasty was nonetheless performed with immediate and lasting pain relief.

scholarly journals Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

2021 ◽  
pp. E335-E340
Author(s):  
Weihua Cai
Keyword(s):  
Risk Factors ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Hounsfield Units ◽  
Secondary Fracture ◽  
Compression Fractures ◽  
Fracture History ◽  
Primary Fracture

Background: In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. Objectives: To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Study Design: Retrospective study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Results: Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 – 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 – 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. Limitations: The main limitation is the retrospective nature of this study. Conclusion: Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention. Key words: Risk factor, vertebral, secondary fracture, osteoporosis

Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture

2005 ◽  
Vol 46 (3) ◽  
pp. 280-287 ◽  
Author(s):  
K.‐R. Han ◽  
C. Kim ◽  
J.‐S. Eun ◽  
Y.‐S. Chung
Keyword(s):  
Vertebral Compression Fracture ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Safe Procedure ◽  
Compression Fractures ◽  
Clinical Complications ◽  
Technical Procedure ◽  
One Year ◽  
Changes Over Time

Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty (PVP) for upper and mid‐thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4–T8 levels. The assessment criteria were changes over time in visual analog scale (VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early (within a week) and one year later, clinical follow‐ups showed that pain intensity had decreased by 50% one day after operation and later by 70–80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate (PMMA) per vertebral body was 3.8±1.2 ml. Leakage of PMMA occurred in one vertebral level (intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid‐thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.

Vertebral Compression Fractures and Options for Treatment

2016 ◽  
Author(s):  
Magdalena Anitescu ◽  
Annie Layno-Moses
Keyword(s):  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Initial Step ◽  
The United States ◽  
Vertebral Compression Fractures ◽  
Invasive Procedures ◽  
First Line ◽  
Compression Fractures ◽  
Prompt Diagnosis

Vertebral compression fracture, a condition that affects almost one quarter of women in the United States, often presents as unrelenting pain with even minor movement. The condition has a significant effect on the decrease in quality of life of patients affected. Prompt diagnosis and treatment are key in the management of this condition. Although a conservative regimen with back braces and analgesics is the first initial step, invasive procedures, such as kyphoplasty and vertebroplasty, may be employed earlier in cases with severe debilitating pain, which is often not improved by first-line treatment.

scholarly journals Appropriate Management of Vertebral Fragility Fractures: Development of a Pathway Based on a Vertebral Compression Fracture Registry

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. E343-E351
Author(s):  
Edward S. Yoon
Keyword(s):  
Vertebral Compression Fracture ◽  
Rating Scale ◽  
Compression Fracture ◽  
Cement Augmentation ◽  
Functional Improvement ◽  
Vertebral Compression Fractures ◽  
Coverage With Evidence Development ◽  
Number Of Patients ◽  
Patient Reported ◽  
And Function

Background: The BenchMarket Medical (BMM) Vertebral Compression Fracture (VCF) Registry, now known as Talosix, is a collaborative effort between Talosix (the authorized registry vendor), Noridian Healthcare Solutions, and clinicians to gather outcomes evidence for cement augmentation treatments in patients with acute painful osteoporotic VCFs. The VCF Registry was designed to provide outcomes evidence to inform the Medicare payer’s “coverage with evidence development” decision to authorize reimbursement for cement augmentation treatments. Objectives: The purpose of this article was to present a pathway for appropriate use of vertebral augmentation based on the findings of the VCF Registry. Study Design: Prospective observational data, including patient characteristics, diagnosis, process of care, and patient-reported outcomes (PROs) for pain and function, were collected from patients undergoing cement augmentation treatment. The PROs were collected at baseline, 1, 3, and 6 months following the procedure. Setting: The VCF Registry is a national ongoing registry with no specified end time or designated sample size. Methods: Primary outcomes were pain improvement measured using the Numeric Rating Scale and function improvement, measured using the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included cement leakage, new neurologic deficits, adverse events, readmissions, and death. Results: The VCF Registry delivered outcomes data to support Noridian’s “coverage with evidence development” decision. A total of 732 patients were included in this study. Registry outcomes confirmed postmarket evidence of highly significant pain relief with mean pain score improvement of 6.5/10 points at 6 months. Function also improved significantly with mean RMDQ score change of 11.4/24 points 6 months after surgery. Results also showed the safety and reliability of cement augmentation. Limitations: The nature of the registry data is that it contains nonrandomized, nonplacebo controlled data and should not be perceived as such. The real-world setting and the large number of patients within the dataset should increase the external validity of the findings. Conclusions: Cement augmentation treatments of patients with acute painful VCFs reliably results in highly significant benefits of pain decrease and functional improvement for this Medicare population. Key words: Vertebral compression fractures, osteoporosis, kyphoplasty, back pain, registry

Treatment of Osteoporotic Vertebral Compression Fracture with Target-Anchored Vertebral Body Plasty

2019 ◽  
Vol 9 (8) ◽  
pp. 1081-1085
Author(s):  
Liu Yang ◽  
Xiangbei Qi ◽  
Tao Lei ◽  
Jingtao Zhang ◽  
Junming Cao
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Target Group ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Traditional Group ◽  
Compression Fractures ◽  
Fracture Area

Objective: To analyze the clinical effect of target-anchored vertebroplasty and traditional percutaneous vertebroplasty on the treatment of osteoporotic vertebral compression fractures. Methods: 50 female New Zealand rabbits were selected for establishing the osteoporotic vertebral compression fracture model and divided into two groups, traditional group and target group followed by analysis of the anterior, posterior, and posterior vertebral body anterior height of the fracture and the injection volume of the bone cement at full filling, and to compare the ultimate compressive strength and stiffness differences between the two groups of specimens by biomechanical testing. Results: In traditional group, the operative time was significantly shorter than that of target group, and the intraoperative bleeding was significantly lower than that of target group (P < 0.05). The fracture area of target group was filled with sufficient bone cement, in the traditional group, 3 cases (12%) showed that bone cement was not filled in the fracture area (P < 0.05), but the total bone cement filling volume was not significantly different between the two groups, but the traditional group had more complete bone cement filling than the bone cement filling, the difference was statistically significant (P < 0.05). In addition, the anterior vertebral body height of each group was significantly higher than other observation points in the group (P < 0.05). However, the distribution of permeability and osmotic type of bone cement between the two groups was not significantly different (P > 0.05). Conclusion: Target-anchored vertebroplasty can improve the quality of clinical treatment of osteoporotic vertebral compression fractures, indicating that it might be a new surgical method.

Orthopedic treatment of vertebral compression fractures in osteoporosis

2011 ◽  
Vol 152 (33) ◽  
pp. 1328-1336
Author(s):  
Péter Pál Varga ◽  
István Béla Bors ◽  
Áron Lazáry
Keyword(s):  
Vertebral Compression Fracture ◽  
Systemic Disease ◽  
Treatment Options ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Orthopedic Treatment ◽  
Adequate Treatment ◽  
Mortality And Morbidity ◽  
Compression Fractures ◽  
Spine Care

Vertebral compression fracture is the most common type of fractures in osteoporosis increasing the mortality and morbidity of the systemic disease. Adequate treatment of the vertebral compression fractures is always in the focus of the national and international spine meetings and one of the most innovative fields in the spine care is the surgical therapy of the osteoporotic spine. Here, the authors summarize the orthopedic treatment options for vertebral compression fractures based on a literature review

Closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures

2004 ◽  
Vol 100 (4) ◽  
pp. 392-396 ◽  
Author(s):  
Shih-Tseng Lee ◽  
Jyi-Feng Chen
Keyword(s):  
Closed Reduction ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Kyphotic Angle ◽  
Content Type ◽  
Compression Fractures ◽  
Fine Print

✓ The purpose of this study was to determine the efficacy and feasibility of closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Two hundred consecutive patients (183 women and 17 men) with single-level osteoporotic vertebral compression fracture were included in this study. After induction of general anesthesia, the patient was placed prone on an operating table. Closed reduction of the fractured and kyphotic spine was achieved by extending the table to restore the kyphotic angle and vertebral body (VB) height. Percutaneous vertebroplasty was then performed to treat the fractured vertebra. The results were quantitatively evaluated, according to the concept of estimated VB height. The anterior, middle, and posterior VB heights of the fractured vertebra were measured preoperatively and immediately after surgery by studying plain standing lateral radiographs. In 162 (81%) of the compression fractures the anterior VB height was restored (57.1 ± 24.8% of lost anterior VB height); in 152 (76%) of the compression fractures the middle VB height was restored (61.4 ± 20.6% of lost middle VB height); and in 52 (26%) of the compression fractures the posterior VB height was restored (51.3 ± 23.1% of lost posterior VB height). In 141 (71.5%) of the compression fractures kyphosis was corrected by 12.5 ± 3.8° [mean 61.6 ± 23.7%]). Closed reduction vertebroplasty is an efficacious and simple method in the treatment of osteoporotic vertebral compression fracture and was able to restore the VB height and kyphotic angle in postions of fractured vertebrae. Its associated, long-term effects on treated vertebrae, however, need further evaluation.

BIOMECHANICAL EVALUATION OF LOW-MODULUS BONE CEMENT FOR ENHANCING APPLICABILITY IN VERTEBROPLASTY — AN EXPERIMENTAL STUDY IN PORCINE MODEL

2018 ◽  
Vol 30 (01) ◽  
pp. 1850002
Author(s):  
Mu-Yi Liu ◽  
Po-Liang Lai ◽  
Ching-Lung Tai
Keyword(s):  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Cement Augmentation ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Height ◽  
Compression Fractures ◽  
Significant Difference ◽  
Compression Stiffness ◽  
Low Modulus

Polymethylmethacrylate (PMMA) bone cement has been widely used in vertebroplasty to treat osteoporotic vertebral compression fracture. However, the high compression stiffness of PMMA is suspected to induce adjacent vertebral fracture following vertebroplasty. In the current study, modified low-modulus cement was prepared by combining PMMA with castor oil to solve this problem. The percentage of height recovery and compression stiffness of vertebral bodies was compared after injection of standard PMMA or low-modulus cement. This study aims to investigate whether low-modulus cement is as effective as standard PMMA for storing the initial vertebral height; while lowering the compression stiffness in treatment of osteoporotic vertebral compression fractures. A total of 20 fresh porcine lumbar vertebrae were assigned into two groups (10 per group): standard and low-modulus. All specimens received a four-week decalcification to mimic human osteoporotic vertebrae. The standard and low-modulus groups received a simulated compression fracture followed by treatment of standard and low-modulus cement augmentation, respectively. The low-modulus cement was prepared by combining standard PMMA with 15% weight fractions of castor oil. For all the 20 specimens, vertebral compression fracture was created by reducing the vertebral height of 25% using a material testing machine. The compression stiffness determined from the creation of compression fracture was defined as the intact group (20 specimens). The fractured vertebrae were then treated with standard and low-modulus cement augmentation. The vertebral height was measured pre- and post-treatment, and the percentage of vertebral height recovery was compared between two cementing groups. Following cement augmentation, axial compression test was conducted to compare compression stiffness among three groups. The results indicated that there is no significant difference in percentage of vertebral height between standard (83.42[Formula: see text][Formula: see text][Formula: see text]11.60%) and low-modulus (88.50[Formula: see text][Formula: see text][Formula: see text]6.15%) groups ([Formula: see text]). Moreover, the compression stiffnesses were 1166.49[Formula: see text][Formula: see text][Formula: see text]392.91 N/mm, 1795.85[Formula: see text][Formula: see text][Formula: see text]247.45[Formula: see text]N/mm and 1362.57[Formula: see text][Formula: see text][Formula: see text]236.92[Formula: see text]N/mm for intact, standard and low-modulus groups, respectively. There is significant difference among three groups ([Formula: see text]). We concluded that the modified low-modulus cement is as effective as standard PMMA for storing the initial vertebral height while lowering the compression stiffness in treatment of osteoporotic vertebral compression fractures. These reduce the risks of adjacent vertebral body fracture following vertebroplasty.

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